Therapeutic Communication Between Nurses and Dementia Patients

Introduction. Giving reassurance

• NP provides the client with a fake reassurance that there is no need to worry over an issue.
• The client’s feelings are undermined as the client becomes reassured there is no need to feel anxious.
• The client feels more anxious about problems that have seemingly no impact on others.
• NP is unwilling to define the stimuli of the problem by “curing” the client with reassurance (Van Noppen et al., 2021).
• Possible replacement: Strong empathy with the client and collaboration.

Rejecting

• NPs create taboos for discussion, limiting the patient’s ability to define the stimuli for the problem.
• The client feels there are “right” and “wrong” topics to discuss during the dialogue.
• The client tries to control their thoughts and loses emotional connection to their story.
• In fear of judgment, the client either stops interacting with NP or increases the distance with the practitioner.
• Possible replacement: encouraging the client to talk by showing genuine interest and empathy.

Approving or disapproving

• NP becomes a self-proclaimed moral compass for the client by approving or disapproving of their actions.
• Some clients can feel the need to “please” the NP in pursuit of a reward in the form of approval.
• Other clients, on the other hand, can be discouraged by disapproval and become more distanced than usual.
• The clients lack understanding of why some of their actions can be frowned upon by others, so they are prone to repeat such behavior in the future.
• Possible replacement: Encouraging a discussion on why others respond positively/negatively to certain behaviors.

Agreeing or disagreeing

• NP explicitly shows agreement or disagreement with the client’s thoughts.
• NP tries to take control over the client’s feelings by labeling them as inherently right or wrong, enabling anxiety and distress.
• The client feels judged by the NP and tries to find the wording that would potentially satisfy the NP, thus, distancing themselves from the emotion.
• While the client feels like they are lectured on their behavior, they fail to understand the underlying reason for their behavior.
• Possible replacement: Initiating an open discussion while letting the client judge their actions afterward.

Giving advice

• NP becomes a behavioral guide for the client by advising them on their actions.
• NP can feel that giving advice is easier as it does not require detailed explanation and discussion with the client.
• The client becomes overly dependent on the NP’s reasoning and directions, limiting their autonomy.
• In the long term, the client finds it hard to operate and think on their own as they seek external directions.
• Possible replacement: Encouraging the client to generate possible responses to a situation and discussing why a particular solution is the best one in a given situation.

Probing

• NP encourages the client to discuss certain aspects of their personal lives despite their readiness to disclose sensitive information.
• The client feels that their personal space is violated, so they feel extremely uncomfortable and anxious.
• Initiating an unpleasant discussion can trigger another psychological trauma for the client (Kalaloi, 2021).
• In the future, the client can become more uncomfortable and reserved, so the progress made so far becomes irrelevant; the client is scared of sharing.
• Possible replacement: Making sure that the topics tackled by the NP do not present any discomfort to a client; in case the client is unwilling to share, the direction of the interaction should be changed immediately.

Introducing an unrelated topic

• The NP changes the topic of discussion when they feel that the current interaction is irrelevant to the issue.
• The NP takes full control of the discussion with no regard to the client’s feelings.
• The client feels like the interaction has a form of an interview rather than a dialogue; they become more cautious about their responses.
• Client feels uncomfortable when they notice that their thoughts provoke a negative NP’s response (Unhjem et al., 2018).
• Possible replacement: Allowing the client to talk about anything that concerns them, putting the client’s well-being above NP’s comfort.

References

Kalaloi, A. F. (2021). Therapeutic communication between nurses and dementia patients at psychiatric hospital. Jurnal Penelitian Komunikasi, 24(2), 117-128. Web.

Unhjem, J. V., Vatne, S., & Hem, M. H. (2018). Transforming nurse–patient relationship: A qualitative study of nurse self‐disclosure in mental health care. Journal of Clinical Nursing, 27(5-6), 798-807. Web.

Van Noppen, B., Sassano-Higgins, S., Appasani, R., & Sapp, F. (2021). Cognitive-behavioral therapy for obsessive-compulsive disorder: 2021 update. Focus, 19(4), 430-443. Web.